Permit --A CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE DEVELOPMENT PLM2001 -00143
All '- i� DATE ISSUED: 4/6/01
13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13333 SW 128TH PL PARCEL: 2S104DA -02600
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
JESS ALWAY, INC PRMT CTR 4/6/01 $36.25 27200100000
24300 SW STAFFORD RD 5PCT CTR 4/6/01 $2.90 27200100000
TUALATIN, OR 97062
Total $39.15
Phone 1: 638 -0718
Contractor:
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone 1: 289 -6498 RP /Backflow Preventer
Reg #: LIC 108025 Final Inspection
PLM 26 -567PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: mi l / r - Permittee Signature: f / ■
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne business day
• Plumbing Permit Application
Date received: 1/ /0 / Permit no f4.,y ,2001-0 / y�
, A 1 Ci of Tigard
' 1 City Tigard
1 Sewerpermit no.: Building permit no.:
' Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By::11(I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory LI Commercial/industrial ❑ Multi - family ❑ Tenant improvement
New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: l
/ 5�, / ? N. Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name: I SFR (3) bath
City /county: Jt &a ✓01 I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: 4 I4 ' y V ' 14 " :42 Manholes
Address: 5901' . /t/ ZIP r5 — ra i-G C. Rain drain connector
City: D [ State: cel ZIP: o 7a /7 Sanitary sewer (no. lin. ft.)
Phone: ep, ;„,1 1E-mail: Storm sewer (no. lin. ft.)
CCB no.: . /c 9-. I Plumb. bus. reg. no: a6 - s6 -71° // Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: R a ✓t 11 Date: h/ 6 0/ Backwater valve
Basins/lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: 1 ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): Floor drains/floor sinks/hub
Garbage disposal
Mailing address:
Hose bibb
City: j State: I ZIP: Ice maker
Phone: I Fax: 1E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: 'State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, Please call jurisdiction for more information Minimum fee $ - �� , 2 S
Notice: This permit application
Cl Visa Cl MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card manner: / / State surcharge (8%) .... $ 9
P within 180 days after it has been 3
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4616 (6A0CCOM)
PLUMBING PERMIT FEES:
•
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 I I Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New I Moved I Replaced I Removed:
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory
•
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal _
Laundry Room Tray .
Washing Machine _
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3 „
Sewer - each additional 100' 46.40 4" _
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00 _
Storm & Rain Drain - each additional 100' 46.40 .
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per /hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
* *PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms \plm- fees.doc 10/10/00
^ CITY OF TIGARD BUILDING INSPECTION DIVISIO
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MS
UP
Date Requested y —/ V AM BLD
Location /3 3» 54. l2r' e Suite MEC
Contact Person Ph 2 -4$ ) , I . y fS PLM 7_,a/ r,3
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: rII
Foundation FPS — I1 '
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS V 'ART FAIL
ost ea Beam
Under Slab
Top Out
Water Service
Sanitary -wer
. ins J
S PA FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Otheoach /Sidewalk Date 4/i b/ I Inspector v � ' � Ext i
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
J Inspection Description Date Passed By J Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
_ Waterproof bsmt walls Electrical rough -in
Slab Electrical service
_ Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG - Structure set-up MEC - Mechanical Permit
Insulation
Drywall nailing -4 Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofmg Lab Final Mechanical final
Structural observation
611 1 7 7 3
Final inspection
call- Plumbing Permit
BUP - Fire Protection System Permit
-4 Inspection Description Date Passed By
3' Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler fmal RP/backflow I reventer ( a
Fire alarm final Rain drain _
Storm drain
Water service
SIT - Site Permit Sanitary sewer
J Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing fmal (//0/6 J 2l
S rinider supply lines (� . - r.0
P PP Y
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils J Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS
CITY TIGARD PLUMBING PERMIT
. I , DEVELOPMENT SERVICES PERMIT #: PLM2001- 00143
�f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/6/01
SITE ADDRESS: 13333 SW 128TH PL PARCEL: 2S104DA 02600
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
JESS ALWAY, INC PRMT CTR 4/6/01 $36.25 27200100000
24300 SW STAFFORD RD 5PCT CTR 4/6/01 $2.90 27200100000
TUALATIN, OR 97062
Total $39.15
Phone 1: 638 -0718
Contractor:
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
•
PORTLAND, OR 97217 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 289-6498
Reg #: LIC 108025 Final Inspection
PLM 26 -567PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Nib
Issued By: 461 i Permittee Signature: / / ill1111►
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne business day ) Y p Y � /►�